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Pancreatic Cyst — SCE Medical Oncology MCQ

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HardGI CancersPancreatic CystSCE Medical Oncology

EUS-FNA of a pancreatic cyst shows CEA 420 ng/mL, bland cytology and high amylase. MRI does not clearly establish duct communication. Which conclusion is justified by the fluid result?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Mucinous lineage is supported, but CEA does not distinguish MCN from IPMN or grade dysplasia

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

A is correct. Cyst-fluid CEA above the traditional 192 ng/mL threshold supports mucinous rather than non-mucinous lineage, but sensitivity and specificity are imperfect. CEA cannot separate MCN from IPMN and does not grade dysplasia or prove invasive malignancy. High amylase suggests communication with the pancreatic duct or a pseudocyst phenotype but does not exclude IPMN. Cytology is specific when malignant cells are found but insensitive, so a bland sample cannot reassure by itself. Management integrates symptoms, duct anatomy, mural nodules, size, growth and operative fitness.

Reference: European evidence-based pancreatic cyst guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC5890653/